Both left and right ventricular functions are reduced in adult survivors of childhood lymphoma and acute lymphoblastic leukemia, according to the PhD thesis of Jon Runar Christiansen.

MAIN RESULTS:

1. Left and right ventricular systolic and diastolic functions are impaired in adults who have survived lymphoma before the age of 18 or acute lymphoblastic leukemia before the age of 16.
2. Ejection fraction is normal in most adult childhood cancer survivors, but global longitudinal strain is reduced in one fourth of the patients with apparently healthy hearts.
3. Radiation therapy and higher doses of anthracyclines are associated with more severe impairments in cardiac function.

THESIS DEFENCE:

Thesis: Cardiac effects in long-term survivors of childhood lymphoma and acute lymphoblastic leukemia
Candidate: Jon Runar Christiansen
Time: September 27, 2017 at 13:15
Place: Domus Medica, University of Oslo: New Auditorium 13
Link to university website (in Norwegian)

SUMMARY:

(1) Survivors of childhood lymphoma have reduced left ventricular diastolic function compared to a healthy control group from the HUNT Study. 29 % of the 125 cancer survivors had diastolic dysfunction, and both valvular disease and diastolic dysfunction were more pronounced after radiotherapy. Systolic function was apparently normal in most participants.

(2) Risk of diastolic dysfunction is also increased in adults who have survived acute lymphoblastic leukemia before the age of 16. The increased risk was only seen in patients treated with anthracyclines, and higher anthracycline doses were associated with greater reductions in diastolic function. Moreover, anthracycline treatment was associated with reduced ventricular systolic function.

Reduced exercise capacity is also common in this group of childhood cancer survivors, and correlated with both reduced cardiac function and higher anthracycline exposure in Christiansen’s study. 138 survivors of childhood acute lymphoblastic leukemia were included.

(3) Adult survivors of childhood lymphoma or acute lymphoblastic leukaemia have impaired right ventricular function compared with healthy controls. Impairements were seen both in survivors treated with radiotherapy, a combination of low-dose radiotherapy and anthracyclines, and anthracyclines only. Survivors unexposed to any of these treatments did not have increased risk of right ventricular dysfunction. Reduced right ventricular function was closely linked to reduced left ventricular function.

(4) Strain echocardiography revealed slight reductions in left ventricular systolic function also in one fourth of the cancer survivors with normal ejection fraction and fractional shortening. Impaired global longitudinal strain was associated with previous exposure to radiotherapy and high doses of anthracyclines.

REFERENCES:

(1) Christiansen, J. R., Hamre, H., Massey, R., Dalen, H., Beitnes, J. O., Fosså, S. D., Kiserud, C. E., & Aakhus, S. (2014). Left ventricular function in long-term survivors of childhood lymphoma. The American journal of cardiology, 114(3), 483-490.

(2) Christiansen, J. R., Kanellopoulos, A., Lund, M. B., Massey, R., Dalen, H., Kiserud, C. E., Ruud, E., & Aakhus, S. (2015). Impaired exercise capacity and left ventricular function in long‐term adult survivors of childhood acute lymphoblastic leukemia. Pediatric blood & cancer, 62(8), 1437-1443.

(3) Christiansen, J. R., Massey, R., Dalen, H., Kanellopoulos, A., Hamre, H., Ruud, E., Kiserud, C. E., Fosså, S. D., & Aakhus, S. (2016). Right ventricular function in long-term adult survivors of childhood lymphoma and acute lymphoblastic leukaemia. European Heart Journal-Cardiovascular Imaging, 17(7), 735-741.

(4) Christiansen, J. R., Massey, R., Dalen, H., Kanellopoulos, A., Hamre, H., Fosså, S. D., Ruud, E., Kiserud, C. E., & Aakhus, S. (2016). Utility of Global Longitudinal Strain by Echocardiography to Detect Left Ventricular Dysfunction in Long-Term Adult Survivors of Childhood Lymphoma and Acute Lymphoblastic Leukemia. The American journal of cardiology, 118(3), 446-452.